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General NPI Number Information
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NPI Number | 1245251255
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Entity Type | Individual
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Provider Name | JAYALAKSHMI ATTALURI MD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 765 N KELLOGG ST SUITE 205
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City | GALESBURG
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State | IL
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Zip | 61401-2875
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Country | US
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Telephone | 309-345-0394
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Fax | 309-345-0130
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Provider Business Mailing Address
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Address Line | 765 N KELLOGG ST SUITE 205
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City | GALESBURG
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State | IL
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Zip | 61401-2875
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Country | US
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Telephone | 309-345-0394
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Fax | 309-345-0130
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036074153
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License Number State | IL
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